Articles: neuralgia.
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Curr Opin Neurol Neurosurg · Apr 1992
ReviewPain mechanisms and the management of neuropathic pain.
The nociceptive system is not fixed, but changes in response to its input and activity. This 'plasticity' comprises dynamic developments of both pro- and antinociceptive processes. Recent advances in the understanding of these processes have important implications for the treatment of persistent neuropathic pain.
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Neuropathic pain, i.e., pain resulting from functional changes in peripheral and central pathways subsequent to injury to the peripheral nervous system, offers a most difficult challenge to therapy. To date, only the antidepressants and the anticonvulsants have shown any effectiveness, albeit incomplete and inconsistent, and many questions remain unanswered: What are the exact indications for the antidepressants? What component of neuropathic pain do they relieve, and through which mechanisms? Which type of antidepressants should be prescribed? A first-generation tricyclic? Or a new compound with a selective action on serotonin reuptake? What are the effective dosage and duration of the treatment? What is it mechanism of action? What other antalgic effects do carbamazepine and baclofen possess apart from their action on trigeminal neuralgia? The opiates are generally considered to be without effect, but recent clinical and experimental findings seem to point otherwise. In the meantime, following a few simple rules will optimize the benefit of drug treatment in neuropathic pain: treatment tailored to individual cases; adequate dosage and duration of treatment. However, it is from the near future that breakthroughs are being expected, dues to the multiplication of animal models and more accurate analysis; new clinical evaluation tools which help in distinguishing the different mechanisms underlying the various aspects of pain; the development of new substances, such as capsaicin, local anesthetics, anti-inflammatory agents (NSAIDs for example); and better defined methodological conditions for therapeutic trials.
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Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. ⋯ High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation.
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We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery.